Direct pull surgical gripper

ABSTRACT

A surgical end effector includes a clevis and two jaws pivotally coupled to the clevis. A wire is coupled to each jaw and extended through a guide way in the other jaw and through an end of the clevis. The jaws may be opened and closed by pushing and pulling on the two cables. Pulling on each wire creates a closing force in both jaws. A rocking pin may be pivotally supported by the clevis and pivotally coupled to the jaws to constrain the jaws to have opposite motions. The clevis may be coupled to an elongate shaft and the wires extended through the shaft to provide an endoscopic instrument. A wire guide may support the wires in the shaft such that they are able to transmit a compressive force without buckling. The wires may carry electricity to the jaws for electrocautery.

BACKGROUND

1. Field

Embodiments of the invention relate to the field of surgicalinstruments; and more specifically, to surgical instruments intended foruse in minimally invasive surgeries.

2. Background

Minimally invasive surgery (MIS) (e.g., endoscopy, laparoscopy,thoracoscopy, cystoscopy, and the like) allows a patient to be operatedupon through small incisions by using elongated surgical instrumentsintroduced to an internal surgical site. Generally, a cannula isinserted through the incision to provide an access port for the surgicalinstruments. The surgical site often comprises a body cavity, such asthe patient's abdomen. The body cavity may optionally be distended usinga clear fluid such as an insufflation gas. In traditional minimallyinvasive surgery, the surgeon manipulates the tissues by usinghand-actuated end effectors of the elongated surgical instruments whileviewing the surgical site on a video monitor.

The elongated surgical instruments will generally have an end effectorin the form of a surgical tool such as a forceps, a scissors, a clamp, aneedle grasper, or the like at one end of an elongate tube. An actuatorthat provides the actuating forces to control the end effector iscoupled to the other end of the elongate tube. A means of coupling theactuator forces to the end effector runs through the elongate tube. Tominimize the size of incision needed for the instrument access port, theelongate tube is generally of a small diameter, preferably about 6millimeters. Thus, it is necessary that the means of coupling theactuator forces to the end effector be compact.

It may be desirable that the elongate tube be somewhat flexible to allowthe surgical instrument to adapt to the geometry of the surgical accesspath. In some cases, the elongate tube may be articulated to provideaccess to a surgical site that is not directly in line with the surgicalaccess port. It may be desirable to use wires as the means of couplingthe actuator forces to the end effector because of the flexibility theyprovide and because of the ability of a wire to transmit a significantforce, a substantial distance, through a small cross-section. However,an unsupported wire is only able to transmit a force in tension. Thus itis generally necessary to provide two wires to transmit a bidirectionalactuating force. This doubles the cross-section required for the wiresto pass through the elongate tube.

The wires need to have sufficient strength to provide the tensionnecessary to create the required forces provided by the end effector.The more tension that is required, the larger the wire cross-sectionmust be. Inefficiencies in converting wire tension into end effectorforces increases the tension, and hence the cross-section, required.Increases in the cross-section, whether because of a greater number ofwires or a larger cross-section of the individual cables, increases theeffect of bending the cable, such as when is passes through anarticulated wrist joint, on the force being delivered by the cable. Thiscan cause changes in the clamping pressure of a surgical end effector asthe end effector is moved by an articulated wrist assembly that supportsthe end effector.

It is also desirable to provide electrical connections to provide anelectrical current for bipolar cautery in which a tissue is cauterizedby current flowing through the tissue. The two connections of oppositepolarity to the tissue can be provided by the two jaws of the surgicalend effector. Thus it is necessary to electrically isolate one jaw fromthe other and provide an insulated electrical connection from each ofthe two jaws to the actuator end of the elongate tube where the cauterycurrent is supplied.

In view of the above, it would be desirable to provide an improvedapparatus and method for transmitting bidirectional actuating forcesthrough an elongate tube and applying those forces to a surgical endeffector of a surgical instrument intended for use in minimally invasivesurgeries that reduces the cross-section required in the elongate tubeand providing electrical connections for the electrical current neededfor bipolar cautery.

SUMMARY

A surgical end effector includes a clevis and two jaws pivotally coupledto the clevis. A wire is coupled to each jaw and extended through aguide way in the other jaw and through an end of the clevis. The jawsmay be opened and closed by pushing and pulling on the two cables.Pulling on each wire creates a closing force in both jaws. A rocking pinmay be pivotally supported by the clevis and pivotally coupled to thejaws to constrain the jaws to have opposite motions. The clevis may becoupled to an elongate shaft and the wires extended through the shaft toprovide an endoscopic instrument. A wire guide may support the wires inthe shaft such that they are able to transmit a compressive forcewithout buckling. The wires may carry electricity to the jaws forelectrocautery.

Other features and advantages of the present invention will be apparentfrom the accompanying drawings and from the detailed description thatfollows below.

BRIEF DESCRIPTION OF THE DRAWINGS

The invention may best be understood by referring to the followingdescription and accompanying drawings that are used to illustrateembodiments of the invention by way of example and not limitation. Inthe drawings, in which like reference numerals indicate similarelements:

FIG. 1 is a simplified perspective view of a robotic surgical systemwith a robotically controlled surgical instrument inserted through aport in a patient's abdomen.

FIG. 2 is a plan view of a surgical instrument for use with a roboticmanipulator.

FIG. 3 is a side view of a surgical end effector.

FIG. 4 is a front view of the surgical end effector of FIG. 3.

FIG. 5 is a front view of the surgical end effector of FIG. 3 with anupper portion removed to allow certain details to be seen more clearly.

FIG. 6 is a front view of another surgical end effector.

FIG. 7 is an end view of yet another surgical end effector.

FIG. 8A is an end view of the surgical end effector of FIG. 7 in aclosed position with one jaw removed to allow certain details to be seenmore clearly.

FIG. 8B is an end view of the surgical end effector of FIG. 7 in aclosed position with both jaws removed to allow certain details to beseen more clearly.

FIG. 9 is a perspective view of the surgical end effector of FIG. 7 in aclosed position with both jaws removed.

FIG. 10 is an exploded view of the surgical end effector of FIG. 7.

FIG. 11A is a front view of a minimally invasive surgical instrumentwith an elongate shaft shown in a section to allow certain details to beseen more clearly.

FIG. 11B is a detailed view of a proximal end of the minimally invasivesurgical instrument shown in FIG. 11A.

FIG. 11C is a detailed view of a central portion of the minimallyinvasive surgical instrument shown in FIG. 11A.

FIG. 11D is a detailed view of a distal end of the minimally invasivesurgical instrument shown in FIG. 11A.

FIG. 12 is a side view of a proximal end of wires and a wire guide.

FIG. 13A is a detailed view of a compression section of the wire guidein an uncompressed condition.

FIG. 13B is a detailed view of a compression section of the wire guidein a compressed condition.

FIG. 14 is a perspective view of a wire support section from thecompression section shown in FIGS. 13A and 13B.

FIG. 15 is a top view of an elongate shaft with a wire guide.

FIG. 16 is a front view of an end effector.

FIG. 17 is a section view of the end effector taken along line 17-17 ofFIG. 15.

FIG. 18 is a front view of an end effector with an articulated wrist.

FIG. 19 is a detailed view of a distal section of the wire guide.

DETAILED DESCRIPTION

In the following description, numerous specific details are set forth.However, it is understood that embodiments of the invention may bepracticed without these specific details. In other instances, well-knowncircuits, structures and techniques have not been shown in detail inorder not to obscure the understanding of this description.

In the following description, reference is made to the accompanyingdrawings, which illustrate several embodiments of the present invention.It is understood that other embodiments may be utilized, and mechanicalcompositional, structural, electrical, and operational changes may bemade without departing from the spirit and scope of the presentdisclosure. The following detailed description is not to be taken in alimiting sense, and the scope of the embodiments of the presentinvention is defined only by the claims of the issued patent.

The terminology used herein is for the purpose of describing particularembodiments only and is not intended to be limiting of the invention.Spatially relative terms, such as “beneath”, “below”, “lower”, “above”,“upper”, and the like may be used herein for ease of description todescribe one element's or feature's relationship to another element(s)or feature(s) as illustrated in the figures. It will be understood thatthe spatially relative terms are intended to encompass differentorientations of the device in use or operation in addition to theorientation depicted in the figures. For example, if the device in thefigures is turned over, elements described as “below” or “beneath” otherelements or features would then be oriented “above” the other elementsor features. Thus, the exemplary term “below” can encompass both anorientation of above and below. The device may be otherwise oriented(e.g., rotated 90 degrees or at other orientations) and the spatiallyrelative descriptors used herein interpreted accordingly.

As used herein, the singular forms “a”, “an”, and “the” are intended toinclude the plural forms as well, unless the context indicatesotherwise. It will be further understood that the terms “comprises”and/or “comprising” specify the presence of stated features, steps,operations, elements, and/or components, but do not preclude thepresence or addition of one or more other features, steps, operations,elements, components, and/or groups thereof.

FIG. 1 is a simplified perspective view of a robotic surgical system100, in accordance with embodiments of the present invention. The system100 includes a support assembly 110 mounted to or near an operatingtable supporting a patient's body 122. The support assembly 110 supportsone or more surgical instruments 120 that operate on a surgical site 126within the patient's body 122. The term “instrument” is used herein todescribe a device configured to be inserted into a patient's body andused to carry out surgical procedures. The instrument includes asurgical tool, such as a forceps, a needle driver, a shears, a bipolarcauterizer, a tissue stabilizer or retractor, a clip applier, ananastomosis device, and the like. The surgical tool used withembodiments of the invention provides some form of gripping in which onepart of the tool opens and closes against another part.

The simplified perspective view of the system 100 shows only a singleinstrument 120 to allow aspects of the invention to be more clearlyseen. A functional robotic surgical system would further include avision system that enables the operator to view the surgical site fromoutside the patient's body 122. The vision system can include a videomonitor for displaying images received by an optical device provided ata distal end of one of the surgical instruments 120. The optical devicecan include a lens coupled to an optical fiber which carries thedetected images to an imaging sensor (e.g., a CCD or CMOS sensor)outside of the patient's body 122. Alternatively, the imaging sensor maybe provided at the distal end of the surgical instrument 120, and thesignals produced by the sensor are transmitted along a lead orwirelessly for display on the monitor. An illustrative monitor is thestereoscopic display on the surgeon's cart in the da Vinci® SurgicalSystem, marketed by Intuitive Surgical, Inc., of Sunnyvale Calif.

A functional robotic surgical system would further include a controlsystem for controlling the insertion and articulation of the surgicalinstruments 120. This control may be effectuated in a variety of ways,depending on the degree of control desired, the size of the surgicalassembly, and other factors. In some embodiments, the control systemincludes one or more manually operated input devices, such as ajoystick, exoskeletal glove, or the like. These input devices controlservo motors which, in turn, control the articulation of the surgicalassembly. The forces generated by the servo motors are transferred viadrivetrain mechanisms, which transmit the forces from the servo motorsgenerated outside the patient's body 122 through an intermediate portionof the elongate surgical instrument 120 to a portion of the surgicalinstrument inside the patient's body 122 distal from the servo motor.Persons familiar with telemanipulative, teleoperative, and telepresencesurgery will know of systems such as the da Vinci® Surgical System andthe Zeus® system originally manufactured by Computer Motion, Inc. andvarious illustrative components of such systems.

The surgical instrument 120 is shown inserted through an entry guidecannula 124, e.g., a single port in the patient's abdomen. A functionalrobotic surgical system may provide an entry guide manipulator (notshown; in one illustrative aspect the entry guide manipulator is part ofthe support system 110) and an instrument manipulator (discussed below).The entry guide 124 is mounted onto the entry guide manipulator, whichincludes a robotic positioning system for positioning the distal end 126of the entry guide 124 at the desired target surgical site. The roboticpositioning system may be provided in a variety of forms, such as aserial link arm having multiple degrees of freedom (e.g., six degrees offreedom) or a jointed arm that provides a remote center of motion (dueto either hardware or software constraints) and which is positioned by asetup joint mounted onto a base. Alternatively, the entry guidemanipulator may be manually maneuvered so as to position the entry guide124 in the desired location. In some telesurgical embodiments, the inputdevices that control the manipulator(s) may be provided at a locationremote from the patient (outside the room in which the patient isplaced). The input signals from the input devices are then transmittedto the control system, which, in turn, manipulates the manipulators 130in response to those signals. The instrument manipulator may be coupledto the entry guide manipulator such that the instrument manipulator 130moves in conjunction with the entry guide 124.

The surgical instrument 120 is detachably connected to the roboticinstrument manipulator 130. The robotic manipulator includes a coupler132 to transfer controller motion from the robotic manipulator to thesurgical instrument 120. The instrument manipulator 130 may provide anumber of controller motions which the surgical instrument 120 maytranslate into a variety of movements of the end effector on thesurgical instrument such that the input provided by a surgeon throughthe control system is translated into a corresponding action by thesurgical instrument.

FIG. 2 is a plan view of an illustrative embodiment of the surgicalinstrument 120, comprising a distal portion 250 and a proximal controlmechanism 240 coupled by an elongate tube 210. The distal portion 250 ofthe surgical instrument 120 can provide any of a variety of surgicaldevices as an end effector such as the forceps shown, a needle driver, ashears, a bipolar cauterizer, a tissue stabilizer or retractor, a clipapplier, an anastomosis device, and the like. Many of the surgicaldevices that may be provided as an end effector have a pair of jaws 252,254 having the ability to be open and closed with a scissor-like motion.This requires that a controller motion provided by the instrumentmanipulator 130 be transmitted through the elongate tube 210 to effectthe opening and closing of the jaws 252, 254.

FIGS. 3 through 5 show an embodiment of a surgical end effector 250.FIG. 3 shows a side view of the surgical end effector 250. FIG. 4 showsa top view of the surgical end effector 250. FIG. 5 shows a top view ofthe surgical end effector 250 with an upper portion removed to allowcertain details to be seen more clearly.

The surgical end effector 250 includes a clevis 300 that pivotallysupports the first jaw 252 and the second jaw 254. A first pivot 302couples the first jaw 252 to the clevis 300. A second pivot 304 couplesthe second jaw 254 to the clevis 300. A first wire 306 is coupled to thefirst jaw 252 by a first fitting 310 crimped to the end of the cable.The first wire 306 extends through a guide way in the second jaw 254 andthrough an end of the clevis 314. A second wire 308 is coupled to thesecond jaw 254 by a second fitting 312 crimped to the end of the cable.The second wire 308 extends through a guide way in the first jaw 252 andthrough the end of the clevis 314. The first and second wires 306, 308provide opening and closing forces to actuate the first and second jaws252, 254.

As best seen in FIG. 5, the guide way 500 guides the wire 308 along acurved path that changes the direction of the wire by roughly 90°. Eachof the first and second jaws 252, 254 includes a face 502 that isperpendicular to the first and second pivots 302, 304. The guide wayincludes a groove 500 in the face 502. In the embodiment shown, the wireis stranded to increase the flexibility and facilitate the ability ofthe wire to follow the curved path. In other embodiments, a solid wireis used to provide greater strength for a given cross-section size ofthe wire.

In one embodiment, the surgical end effector further includes twoliners. Each liner is coupled to a face of one of the jaws and fittedwithin the groove 500 that forms the guide way. Thus the guide waysinclude a portion of the liners. The liners reduce the friction as thewires 306, 308 slide within the guide ways. The liners also electricallyisolate the wires 306, 308 from the jaw through which they slide. Theliners are further described and illustrated below for the embodimentshown in FIGS. 7-10.

The arrangement of the wires 306, 308 causes tension in each wire toapply a closing force to both jaws 252, 254. For example, when tensionis applied to the second wire 308, the coupling 312 to the second jaw254 will pull on the jaw to close it. At the same time, the tensionapplied to the second wire 308 will create a closing force on the firstjaw 252 because of the forces created in the guide way as the secondwire is turned by the guide way. Likewise, a compression force appliedto each wire creates an opening force on both jaws 252, 254. This wirearrangement permits higher opening and closing forces to be generated bya more compact end effector.

In the embodiment shown, the first and second jaws 252, 254 and thefirst and second wires 206, 208 are electrically conductive. The clevis300 and the first and second pivots 302, 304 are electricallynon-conductive. This allows an electrical current to be supplied to thefirst and second jaws 252, 254 by the first and second wires 206, 208for the purpose of performing bipolar electrocautery in which a tissueis cauterized by the current flowing from one jaw to the other throughthe tissue.

FIG. 6 shows a top view of another surgical end effector 650. As in thepreviously described end effector, first and second wires 606, 608 arecoupled 610, 612 to first and second jaws 652, 654 supported by a clevis600 to provide the opening and closing forces. In this embodiment thefirst and second pivots 602 are joined together coaxially and areprovided as a single element of the device.

FIGS. 7 through 10 show another surgical end effector 750. As in thepreviously described end effectors, first and second wires 706, 708provide the opening and closing forces for the first and second jaws752, 754. The guide ways 716, 718 in the faces 720, 722 of the jaws 752,754 can be seen in FIG. 7. In this embodiment a rocking pin 702 ispivotally supported by the clevis 700. The rocking pin 702 is pivotallycoupled to the first and second jaws 752, 754 such that the rocking pinconstrains the first and second jaws to have opposite motions.

FIG. 8A shows the surgical end effector 750 in a closed position withone of the two jaws removed so that the rocking pin 702 can be partiallyseen. FIG. 8B shows the surgical end effector 750 in a closed positionwith both jaws removed so that the rocking pin 702 can be clearly seen.FIG. 9 shows the surgical end effector 750 in a perspective view thatallows the relationship between the clevis 700 and the rocking pin 702to be seen more clearly. FIG. 10 shows the surgical end effector 750 inan exploded view that allows the parts of the end effector to be seenmore clearly. In the embodiment shown, the rocking pin 702 is pivotallysupported by the clevis 700 at its midpoint. Therefore the rocking pinconstrains the first and second jaws to have equal and opposite motions.In other embodiments, the rocking pin 702 is pivotally supported by theclevis 700 at other positions so that there is a ratio between theamount of the movement of each jaw other than 1:1.

The first and second jaws 752, 754 and the first and second wires 706,708 can be electrically conductive. In the embodiment shown, a connector1010, 1012 is crimped onto an end of each wire 706, 708. Each connector1010, 1012 includes a shank 1006, 1008 that engages an opening 1022,1024 in the jaw 752, 754 to provide both a mechanical and an electricalconnection. The end of the shank 1006, 1008 is expanded after beinginserted in the opening 1018, 1020 in the jaw 752, 754 to make a tightconnection between the wire and the jaw. This allows an electricalcurrent to be supplied to the first and second jaws 752, 754 by thefirst and second wires 706, 708 for the purpose of performing bipolarelectrocautery in which a tissue is cauterized by the current flowingfrom one jaw to the other through the tissue.

Bipolar electrocautery requires that the first and second jaws 752, 754be electrically isolated from one another except for the conductive pathformed between the jaws when grasping a tissue. In the embodiment shown,the clevis 700 and the cap 1000 that encloses the moving parts withinthe clevis are electrically non-conductive. It is also necessary thatthe rocking pin 702 be prevented from providing a conductive pathbetween the jaws 752, 754. This can be accomplished by making therocking pin 702 from a non-conductive material. In the embodiment shown,non-conductive liners 1014, 1016 are added to provide the faces of thefirst and second jaws 752, 754. The liners 1014, 1016 interrupt theconductive path between the jaws 752, 754 and allow the rocking pin 702to be made of metal.

The liners 1014, 1016 further provide the guide ways 716, 718 thatsupport the wires 706, 708. The liners 1014, 1016 can be constructed ofa plastic material with guide ways 716, 718 that reduce the friction onthe insulating jacket on the wires 706, 708. In the embodiment shown,the guide ways 716, 718 surround somewhat more than half of thecircumference of the wire in the guide way. In other embodiments, theguide ways completely surround the wire in the guide way. In still otherembodiments, the guide ways surround half of the circumference of thewire in the guide way or somewhat less.

FIG. 11A shows the elongate shaft 210 of the minimally invasive surgicalinstrument 120 shown in FIG. 2. FIGS. 11B through 11D show portions ofthe elongate shaft 210 in greater detail. It will be appreciated thatFIGS. 11B through 11D do not collectively show the entire length of theelongate shaft 210, and that there are overlapping portions betweenthese figures. The surgical end effector 750 shown in FIGS. 7-10 isshown coupled to a distal end 1112 of the elongate shaft 210 as anexemplary end effector. It will be appreciated that any embodiment ofthe end effector can be used with the elongate shaft 210.

The elongate shaft 210 includes a distal end 1112, a proximal end 1110,and a longitudinal axis extending between the distal end and theproximal end. The longitudinal axis is the axis of rotation, or axis ofsymmetry, of the elongate shaft 210. The clevis 700 of the end effector250 is coupled to the distal end 1112 of the elongate shaft 210. Asdescribed above, the first and second jaws 752, 754 are pivotallycoupled to the clevis 700. The first and second wires 706, 708 emergefrom the end 1114 of the clevis as described above and extend throughthe elongate shaft 210 along the longitudinal axis between the distalend 512 and the proximal end 510. In one embodiment, the elongate shafthas a relatively small diameter of perhaps 5 to 6 mm.

In one embodiment, the first and second wires 706, 708 are of a strandedconstruction to provide the flexibility required to slide within theguide ways 716, 718 of the jaws 752, 754. The wires are constructed of amaterial such as nitinol or tungsten that provides high strength so thatthe cross-section of the wire can be minimized. The wire material andconstruction is also chosen to be durable through the repeated bendingcycles imposed by sliding the wire through the curved guide way as thejaws as the end effector are opened and closed. In one embodiment thewires are insulated so that the only conductive metal exposed on them isat the distal end where it attached to the jaw, and at the proximal endwhere it is crimped into a connector pin. In one embodiment theinsulation is ethylene tetrafluoroethylene (ETFE such as Tefzel® 750).

It will be appreciated that it is necessary to transmit a compressiveforce through the wires to provide an opening force for the jaws of theend effector. It will be further appreciated that it is necessary tosupport the wires so that the wires are able to transmit a compressiveforce without buckling. It is desirable to minimize the unsupportedlength of each wire to allow a higher compressive load to be appliedwithout buckling the cable. For example, for a typical wireconfiguration that might be used in a 5 to 6 mm diameter elongate shaft,it is desirable to keep the unsupported length of wire less than onequarter of an inch and still more desirable to have a maximumunsupported length closer to 1/16 of an inch. Therefore the minimallyinvasive surgical instrument 120 includes a wire guide 1100 coupled tothe clevis 700 and to the first and second wires 706, 708 along thelongitudinal (end to end) axis of the elongate shaft 210. The wire guide1100 supports the first and second wires 706, 708 such that the firstand second wires are able to transmit a compressive force withoutbuckling.

The wire guide 1100 includes a proximal section 1102 adjacent theproximal end 1110 of the elongate shaft 210, a working section 1106adjacent the working (distal) end 1112 of the elongate shaft 210, and acompression section 1104 coupled between the proximal section and theworking section.

At least a portion of the proximal section 1102 of the wire guide 1100is fixed to the first and second wires 706, 708 so that forces can beapplied to the wires by gripping the proximal section and applying theforces to the proximal section. In the embodiment shown, a portion 1108of the proximal section 1102 of the wire guide 1100 extends beyond theproximal end 1110 of the elongate shaft 210 to facilitate gripping theproximal section. In one embodiment, the proximal section 1102 of thewire guide 1100 includes an outer metal tube with a wire supportinserted into the tube. The first and second wires 706, 708 pass throughopenings in the wire support. In one embodiment, the wire support ismade of fluorinated ethylene propylene, (Teflon®-FEP or FEP). FEP meltsat substantially the same temperature as ETFE allowing heat to be usedto join together the wire insulation, wire support, and the metal tube.The FEP comes through slots in the metal, creating a mechanicalconnection. In this way, the wires 706, 708 can be mechanically drivenby grabbing the metal tube while keeping the wires electricallyisolated.

FIG. 12 shows a side view of the portion 1108 of the proximal section1102 of the wire guide 1100 that extends beyond the proximal end 1110 ofthe elongate shaft 210. The first and second wires 706, 708 extend fromthe wire guide to facilitate making electrical connections to thecables.

Referring again to FIG. 11B, in the embodiment shown the elongate shaft210 rotates relative to the proximal control mechanism 240 (FIG. 2) toprovide an additional motion of the end effector 750. The proximalsection 1102 of the wire guide 1100 is made in two pieces 1120, 1124.The upper piece 1120 of the proximal section 1102 is held in a fixedposition relative to the proximal control mechanism 240 to accommodatethe gripping of the proximal section and the electrical connections tothe cables. The lower piece 1124 of the proximal section 1102 is coupledto the elongate shaft 210 to rotate with it. The two pieces 1120, 1124rotate relative to each other at the joint 1122 between the pieces. Thewire insulation, wire support, and the metal tube are joined together atthe distal end of each of the two pieces 1120, 1124. This leaves a longlength of the wires 706, 708 that can twist within the lower piece 1124of the proximal section 1102 as the elongate shaft 210 rotates. Theupper piece 1120 in the embodiment shown is about 4 inches long and thelower piece 1124 is about 16 inches long.

The distal end of the working section 1106 of the wire guide 1100 isfixed to the clevis 700 of the end effector 750. The wires 706, 708slide within grooves in the working section 1106 parallel to thelongitudinal axis of the elongate shaft 210. In one embodiment, theworking section 1106 provides lateral flexibility to accommodateflexibility and/or articulation in the elongate shaft 210.

If a portion of the proximal section 1102 of the wire guide 1100 isfixed to the first and second wires 706, 708, then the overall length ofthe wire guide 1100 will change as forces are applied to the wires byapplying the forces to the proximal section. The compression section1104 coupled to the proximal section 1102 and the working section 1106accommodates these changes in length while providing support for thewires to prevent buckling.

FIG. 11C shows the portion of the elongate shaft 210 that includes thecompression section 1104 of the wire guide 1100. FIG. 13A shows aportion of the compression section in an uncompressed condition. FIG.13B shows a portion of the compression section in a compressedcondition. FIG. 14 shows a perspective view of a wire support section1300 that is used to form the compression section 1104.

In the embodiment shown, the compression section 1104 is formed bycoupling a number of wire support sections 1300 with compression springs1306. As best seen in FIGS. 13A and 14, the wires 706, 708 pass-throughguideways 1402, 1404 in the wire support section 1300 and are furthersupported by the compression springs 1306 that connect the supportsections. The compression section 1104 of the wire guide 210 allows thewire guide to change length as the proximal section 1102 is moved toapply forces through the wires 706, 708. The compression section 1104allows the wire guide 1100 to be reduced in length when a compressionforce is applied to the proximal section 1102. This feature allows acompression force to be applied to the wires 706, 708 while providingthe support necessary to prevent buckling of the cables.

As may be seen in FIG. 13A, the length of the compression springs 1306when uncompressed is chosen to be twice the length of the portion 1406of the wire support section 1300 to which the spring is coupled plus thedesired maximum unsupported length of the cable.

As may be seen in FIG. 13B, the compression springs 1306 may becompressed to the point where the end face 1304 of one wire supportsection 1300 contacts the opposing end face 1302 of an adjacent wiresupport section. Thus each compression spring 1306 allows a change oflength roughly equal to the unsupported length when the spring isuncompressed. Any desired number of compression sections 1300 can beused to form the compression section 1104 to provide the desired travelof the proximal section 1102 relative to the working section 1106.

FIGS. 15 through 17 show details of the coupling of the end effector 750to the distal end 1112 of the elongate shaft 210. FIG. 15 is a top viewof the elongate shaft 210 with the wire guide 1100 shown along thelongitudinal axis. FIG. 16 is a front view of the end effector 750coupled to the distal end 1112 of the elongate shaft 210 with the jaws752, 754 in an open position. FIG. 17 is a section view of the endeffector 750 taken along line 17-17 of FIG. 15 with the second jaw 754not shown for clarity.

As best seen in FIG. 17, the clevis 700 of the end effector 750 is fixedto the end of the wire guide 1100. Thus a wire 708 slides through aguideway of a jaw 752, emerges from the end 1114 of the clevis 700, andextends through the wire guide 1100 to the proximal end 1110 of theelongate shaft 210. As previously described, an end 712 of the wire 708is coupled to a first jaw 754 and then extends through a guideway of asecond jaw 752 such that tension and compression of the wire createsclosing and opening forces on the first and second jaws which areconnected to the clevis 700 by pivots 704. A rocking pin 702 ispivotally supported by the clevis 700 and pivotally coupled to the firstand second jaws 752, 754 such that the rocking pin constrains the firstand second jaws to have equal and opposite motions.

FIG. 18 is a front view of the end effector 750 coupled to the distalend 1112 of the elongate shaft 210 by an articulated wrist assembly1800. The distal end of the working section 1106 of the wire guide 1100passes through the articulated wrist assembly 1800 along its centralaxis and is fixed to the clevis 700 of the end effector 750. The wires706, 708 slide within grooves in the working section 1106 parallel tothe longitudinal axis of the elongate shaft 210. The working section1106 provides lateral flexibility to accommodate the movement at thejoints of the articulated wrist assembly 1800. In the embodiment shown,the distal end of the working section 1106 includes perforations in theouter tube at least at the most distal portion to allow fluids to drainfrom the wire guide 1100. As may be seen in FIG. 11C, in someembodiments portions of the working section 1106 are provided with aprotective covering, such as spring wire, to protect the guide fromabrasion where it passes through articulated joints. Other forms ofarticulated wrist assemblies with greater or fewer degrees of freedommay also be used to couple the end effector to the distal end of theelongate shaft.

FIG. 19 is a detailed view of a distal section of the wire guide. In theembodiment shown, the guideways 1900, 1902 for the two wires provide a360 degree twist in the portion of the wire guide that passes throughthe wrist. This tends to compensate for the slight differences in pathlength that result from bending of the wire guide as the wrist isarticulated. An enlarged portion 1904 of the wire guide is coupled tothe distal part of the instrument so that the wire guide 1106 can'trotate or pull away from the clevis 750.

While certain exemplary embodiments have been described and shown in theaccompanying drawings, it is to be understood that such embodiments aremerely illustrative of and not restrictive on the broad invention, andthat this invention is not limited to the specific constructions andarrangements shown and described, since various other modifications mayoccur to those of ordinary skill in the art. The description is thus tobe regarded as illustrative instead of limiting.

What is claimed is:
 1. A surgical end effector comprising: a clevis; afirst jaw; a first pivot that couples the first jaw to the clevis; asecond jaw; a second pivot that couples the second jaw to the clevis; afirst wire coupled to the first jaw to transmit a controller motion tothe first jaw and to the second jaw; a second wire coupled to the secondjaw to transmit the controller motion to the second jaw and to the firstjaw; a first guide way in the first jaw, the first guide way being afirst curved path that extends from the second jaw to the clevis,changes direction by roughly ninety degrees, and includes a continuousfirst surface that extends from the second jaw to the clevis along theinside of the first curved path, the second wire extending in the firstguide way along the first surface to the second jaw; and a second guideway in the second jaw, the second guide way being a second curved paththat extends from the first jaw to the clevis, changes direction byroughly ninety degrees, and includes a continuous second surface thatextends from the first jaw to the clevis along the inside of the secondcurved path, the first wire extending in the first guide way along thesecond surface to the first jaw.
 2. The surgical end effector of claim 1wherein the first and second pivots are coaxial.
 3. The surgical endeffector of claim 1 further comprising a rocking pin pivotally supportedby the clevis and pivotally coupled to the first and second jaws suchthat the rocking pin constrains the first and second jaws to haveopposite motions.
 4. The surgical end effector of claim 1 wherein thefirst guide way and the second guide way each include a groove definedin a face perpendicular to the pivot axis of the pivots.
 5. The surgicalend effector of claim 4 further comprising a first and a second liner,each liner fitted within the groove of one of the first guide way andthe second guide way, the guide ways including a portion of the liners.6. The surgical end effector of claim 1 wherein the first and secondjaws and the first and second wires are electrically conductive, and theclevis is electrically non-conductive.
 7. The surgical end effector ofclaim 6 further comprising electrically non-conductive liners coupled tothe first and second jaws and a rocking pin pivotally supported by theclevis and pivotally coupled to the first and second jaws such that therocking pin constrains the first and second jaws to have oppositemotions, the rocking pin being electrically isolated from the first andsecond jaws by the liners.
 8. A minimally invasive surgical instrumentcomprising: an elongate shaft having a distal end, a proximal end, and alongitudinal axis extending between the distal end and the proximal end;an end effector having a clevis coupled to the distal end of theelongate shaft, a first jaw pivotally coupled to the clevis, and asecond jaw pivotally coupled to the clevis; a first wire coupled to thefirst jaw to transmit a controller motion to the first jaw and to thesecond jaw, the first wire extending through a second guide way in thesecond jaw and through the elongate shaft between the distal end and theproximal end, the second guide way being a second curved path thatextends from the first jaw to the clevis, changes direction by roughlyninety degrees, and includes a continuous second surface that extendsfrom the first jaw to the clevis along the inside of the second curvedpath; and a second wire coupled to the second jaw to transmit thecontroller motion to the second jaw and to the first jaw, the secondwire extending through a first guide way in the first jaw and throughthe elongate shaft between the distal end and the proximal end, thefirst guide way being a first curved path that extends from the secondjaw to the clevis, changes direction by roughly ninety degrees, andincludes a continuous first surface that extends from the second jaw tothe clevis along the inside of the first curved path.
 9. The minimallyinvasive surgical instrument of claim 8 wherein the end effector furtherhas a rocking pin pivotally supported by the clevis and pivotallycoupled to the first and second jaws such that the rocking pinconstrains the first and second jaws to have opposite motions.
 10. Theminimally invasive surgical instrument of claim 8 wherein each of thefirst and second jaws includes a face that is perpendicular to thepivotal coupling, the first guide way including a groove in the face ofthe first jaw, the second guide way including a groove in the face ofthe second jaw.
 11. The minimally invasive surgical instrument of claim10 wherein the first and second jaws and the first and second wires areelectrically conductive, and the clevis is electrically non-conductive,such that the first jaw and first wire are electrically isolated fromthe second jaw and second wire.
 12. The minimally invasive surgicalinstrument of claim 11 further comprising electrically non-conductiveliners, each liner fitted within the groove of one of the first guideway and the second guide way, the guide ways including a portion of theliners, and a rocking pin pivotally supported by the clevis andpivotally coupled to the first and second jaws such that the rocking pinconstrains the first and second jaws to have opposite motions, therocking pin being electrically isolated from the first and second jawsby the liners.
 13. The minimally invasive surgical instrument of claim 8further comprising a wire guide coupled to the clevis and to the firstand second wires along the longitudinal axis of the elongate shaft, thewire guide supporting the first and second wires such that the first andsecond wires are able to transmit a compressive force without buckling.14. The minimally invasive surgical instrument of claim 13 wherein thewire guide includes a proximal section adjacent the proximal end of theelongate shaft, a working section adjacent the distal end of theelongate shaft, and a compression section coupled to the proximalsection and the working section, the compression section including aplurality of wire support sections coupled to a compression spring suchthat the wire guide is reduced in length when a compression force isapplied.
 15. The minimally invasive surgical instrument of claim 8wherein the end effector further including means for constraining thefirst and second jaws to have opposite motions.
 16. The minimallyinvasive surgical instrument of claim 15 further comprising means forelectrically isolating the first jaw and wire from the second jaw andcable.
 17. The minimally invasive surgical instrument of claim 8 furthercomprising means for preventing buckling of the first and second wireswhen transmitting a compressive force.
 18. The minimally invasivesurgical instrument of claim 17 wherein the means for preventingbuckling is shortened when transmitting the compressive force.
 19. Asurgical end effector comprising: a clevis; a first jaw rotatablycoupled to the clevis by a first pivot, the first jaw having a firstface perpendicular to the axis of rotation of the first pivot and afirst guide way, the first guide way being a first curved path in thefirst face that extends from the clevis, changes direction by roughlyninety degrees, and includes a continuous first surface that extendsfrom the second jaw to the clevis along the inside of the first curvedpath; a second jaw rotatably coupled to the clevis by a second pivot,the second jaw having a second face perpendicular to the axis ofrotation of the second pivot and a second guide way, the second guideway being a second curved path in the second face that extends from thefirst jaw to the clevis, changes direction by roughly ninety degrees,and includes a continuous second surface that extends from the first jawto the clevis along the inside of the second curved path; a first wirecoupled to the first jaw to transmit a controller motion to the firstjaw and to the second jaw and extending through the second guide way tothe clevis; and a second wire coupled to the second jaw to transmit thecontroller motion to the second jaw and to the first jaw and extendingthrough the first guide way to the clevis.